Female Graffiti Artist Struggles to Make a Mark in Kabul - Video

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Predicting Risk Factors for Intimate Partner Violence among Post-9/11 College Student Veterans

The current conflicts in Afghanistan and Iraq present unique risk factors for military personnel that increase the likelihood of psychological distress and concomitant consequences related to trauma. Several studies have found that the stress brought about by financial difficulties, unemployment, and the need to renegotiate roles and responsibilities with spouses following discharge increases the likelihood of relationship strain and even intimate partner violence in the veteran population. 

This study was undertaken to determine the challenges related to maintaining healthy relationships for college student veterans who have served in the armed forces since September 11, 2001. Psychological distress, substance use, and hypermasculine attitudes were explored as risk factors for intimate violence. 

Social support was found to be a protective buffer against psychological aggression. However, approximately a third of college student veterans reported low social support along with symptoms of distress, placing them at elevated risk of partner abuse. 

The current article explores models for predicting risk of perpetrating aggression in college student veterans and concludes that culturally tailored programs and services are needed.

Purchase full article at:   http://goo.gl/BlzXsH

By:   Klaw EL1, Demers AL2, Da Silva N2.

• 1San José State University, CA, USA elena.klaw@sjsu.edu.
• 2San José State University, CA, USA. 

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Hepatitis C Virus and HIV Infections among People Who Inject Drugs in the Middle East and North Africa: A Neglected Public Health Burden?

People who inject drugs (PWID) are a key population at risk of hepatitis C virus (HCV) and HIV infections. Globally, 63% of PWID are HCV infected [1, 2] and 19% are HIV infected [2], leading to an estimated 10 million and 3 million HCV- and HIV-infected PWID, respectively [1–3]. The Middle East and North Africa (MENA), a region comprising 23 countries from Morocco in the West to Pakistan in the East, is at the centre of major drug production and trade, creating a context of vulnerability to injecting drug use [4]. PWID in MENA are a large, mostly young and stigmatized population experiencing a substantial HCV and HIV burden, with potential for even further HIV epidemic growth. Yet, they lack access to comprehensive and confidential HCV and HIV testing, prevention and treatment services.

Below:  Median HCV prevalence among people who inject drugs in the Middle East and North Africa as per available studies [6]. Error bars represent the lower and upper bounds of the interquartile range if more than one data point was available per country.

Full article at:   http://goo.gl/qK72Up

By:   Ghina R Mumtaz,§,1,2 Helen A Weiss,3 and Laith J Abu-Raddad1,4

¹Infectious Disease Epidemiology Group, Weill Cornell Medical College – Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar

²Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

³MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

⁴Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA

^§Corresponding author: Ghina R Mumtaz, Infectious Disease Epidemiology Group, Weill Cornell Medical College – Qatar, Cornell University, Qatar Foundation – Education City, P.O. Box 24144, Doha, Qatar. Tel: +(974) 4492 8406. Fax: +(974) 4492 8422. (Email:ude.llenroc.dem-rataq@6002mig) 

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Aggressive and Violent Behavior among Military Personnel Deployed to Iraq and Afghanistan: Prevalence and Link with Deployment and Combat Exposure

A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or Afghanistan; the relationship with deployment and combat exposure; and the role that mental health problems, such as post-traumatic stress disorder (PTSD), have on the pathway between deployment and combat to violence. 

Seventeen studies published between January 1, 2001, and February 12, 2014, in the United States and the United Kingdom met the inclusion criteria. Despite methodological differences across studies, aggressive behavior was found to be prevalent among serving and formerly serving personnel, with pooled estimates of 10% (95% confidence interval (CI): 1, 20) for physical assault and 29% (95% CI: 25, 36) for all types of physical aggression in the last month, and worthy of further exploration. In both countries, rates were increased among combat-exposed, formerly serving personnel. 

The majority of studies suggested a small-to-moderate association between combat exposure and postdeployment physical aggression and violence, with a pooled estimate of the weighted odds ratio = 3.24 (95% CI: 2.75, 3.82), with several studies finding that violence increased with intensity and frequency of exposure to combat traumas. The review's findings support the mediating role of PTSD between combat and postdeployment violence and the importance of alcohol, especially if comorbid with PTSD.

Full PDF article at:  http://goo.gl/tfAkP2

By:  Deirdre MacManus^*, Roberto Rona,Hannah Dickson,Greta Somaini,Nicola Fear andSimon Wessely

^*Correspondence to Dr. Deirdre MacManus, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom (e-mail: deirdre.macmanus@kcl.ac.uk).

 

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The Influence of Military Sexual Trauma on Returning OEF/OIF Male Veterans

Military sexual trauma (MST) encompasses experiences of sexual harassment and/or assault that occur during active duty military service. MST is associated with postdeployment mental health, interpersonal, and physical difficulties and appears to be more influential in the development of posttraumatic stress disorder (PTSD) than other active duty experiences, including combat, among women veterans. 

Although some literature suggests that men who experience MST also evidence significant postdeployment difficulties, research in this area is lacking. The current study evaluated a large sample of returning male veterans (N = 961) who served in Iraq and/or Afghanistan. Veterans were referred for treatment in a trauma and anxiety specialty clinic at a large VA hospital. 

Of this sample, 18% reported MST perpetrated by a member of their unit. Results indicated veterans who reported MST were younger, less likely to be currently married, more likely to be diagnosed with a mood disorder, and more likely to have experienced non-MST sexual abuse either as children or adults. 

Analyses revealed that MST was negatively associated with postdeployment social support and positively associated with postdeployment perceived emotional mistreatment, but was not associated with postdeployment loss of romantic relationship, job loss, or unemployment after statistically controlling for other trauma exposures and current social support. 

Results reflect the detrimental associations of MST on male veterans and the need for more research in this area. These findings also highlight the need for treatment interventions that address social and interpersonal functioning in addition to symptoms of depressive disorders

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By: Mondragon SA1, Wang D1, Pritchett L1, Graham DP1, Plasencia ML1, Teng EJ1.

• 1Michael E. DeBakey VA Medical Center.  

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Functional Correlates of Military Sexual Assault in Male Veterans

Despite research findings that similar numbers of male and female veterans are affected by military sexual trauma (MST), there has been considerably less research on the effects of MST specific to male veterans. 

The aim of the present study was to provide preliminary data describing functional correlates of military sexual assault (MSA) among male Iraq/Afghanistan-era veterans to identify potential health care needs for this population. We evaluated the following functional correlates: posttraumatic stress disorder (PTSD) symptoms, depression symptoms, alcohol use, drug use, suicidality, social support, violent behavior in the past 30 days, incarceration, disability eligibility status, and use of outpatient mental health treatment. 

We compared 3 groups: (a) male veterans who endorsed a history of MSA (n = 39), (b) a general non-MSA sample (n = 2,003), and (c) a matched non-MSA sample (n = 39) identified by matching algorithms on the basis of factors (e.g., age, education, adult premilitary sexual trauma history, childhood sexual and physical trauma history, and race) that could increase veterans' vulnerability to the functional correlates examined. 

MSA in men was associated with greater PTSD symptom severity, greater depression symptom severity, higher suicidality, and higher outpatient mental health treatment, above and beyond the effects of vulnerability factors. These findings suggest that, for male veterans, MSA may result in a severe and enduring overall symptom profile requiring ongoing clinical management.

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By: Schry AR1, Hibberd R2, Wagner HR1, Turchik JA3, Kimbrel NA1, Wong M1, Elbogen EE1, Strauss JL4, Brancu M1; Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center Workgroup.

• 1Veterans Affairs Mid-Atlantic Mental Illness Research.
• 2Durham Veterans Affairs Medical Center.
• 3Veterans Affairs Palo Alto Health Care System.
• 4Duke University School of Medicine, and Mental Health Services  

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Hepatitis C & HIV Incidence & Harm Reduction Program Use in a Conflict Setting: An Observational Cohort of Injecting Drug Users in Kabul, Afghanistan

Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan.

Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007–December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models.

Of 483 IDUs enrolled, 385 completed one or more follow-up visits. All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y and 1.5/100 p-y, respectively. Changing from injecting to smoking was protective for HCV acquisition, while duration of injecting and sharing syringes independently predicted HIV infection.

There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support.

Below:  Insurgent attacks and incident hepatitis C cases among male injecting drug users in Kabul, Afghanistan, June 2007–December 2009 (n = 191)

Full article at: http://goo.gl/Qnnsh2

By: Catherine S. Todd, Abdul Nasir, Mohammad Raza Stanekzai, Katja Fiekert, Heather L. Sipsma, David Vlahov, andSteffanie A. Strathdee

Department of Obstetrics & Gynecology, College of Physicians and Surgeons, and Heilbrunn Department of Population & Family Health, Columbia University, Mailman School of Public Health, PH 16-69, 622 West 168th Street, New York, NY 10032 USA

Health Protection and Research Organisation, Street 4, Taimani, Kabul, Afghanistan

Department of Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034 USA

Department of Community Health Systems, University of California, San Francisco School of Nursing, 2 Koret Way, #N-319X UCSF Box 0602, San Francisco, CA 94143-0602 USA

Division of Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507 USA

Asia Pacific Business Unit and Clinical Sciences Division, FHI 360, Sindhorn Building, 130-132 Wittayu Road, Bangkok, 10330 Thailand

  

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Do Child Abuse and Maternal Care Interact to Predict Military Sexual Trauma?

The present research tested the hypothesis that maternal care moderates the relationship between childhood sexual abuse and subsequent military sexual trauma (MST).

Measures of childhood sexual abuse, maternal care, and MST were administered to 197 Iraq and Afghanistan war veterans.

After accounting for gender, age, and the main effects of maternal care and childhood sexual abuse, the maternal care x childhood sexual abuse interaction was a significant predictor of MST. As hypothesized, rates of MST were higher among veterans who reported childhood sexual abuse and low levels of maternal care (43%) compared with veterans who reported childhood sexual abuse and high levels of maternal care (11%).

These findings suggest that high levels of maternal care may act as a protective factor against future revictimization among military service members. These findings have the potential to inform both prevention and intervention efforts.

Via: http://ht.ly/Sa1DY 

By: Wilson LC1, Kimbrel NA, Meyer EC, Young KA, Morissette SB.

1Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans; University of Mary Washington, Fredericksburg

Cross-Sectional Assessments of Participants’ Characteristics & Loss To Follow-Up in the First Opioid Substitution Therapy Pilot Program in Kabul, Afghanistan

Below: Participants enrolled and surveyed in the OSTPP between February 2010 and May 2012. Eighty-three participants were initially enrolled and surveyed by MdM, 38 dropped-out, and 45 were retained. After 18 months, 57 clients were surveyed by JHU

Two cross-sectional surveys evaluated participants attending the OSTPP at baseline (n = 83) and 18 months after (n = 57). Questionnaires assessed socio-demographic, drug use behavior, and general and mental health factors. After 18 months, 57 participants remained in the OSTPP. Participants lost to follow-up were younger (p < 0.01) and married (p < 0.01) and had no family contact (p < 0.01). Participants at 18 months reported no criminal activity in the last month and only two (3.5 %) reported heroin use in the last month, constituting significant decreases from baseline.

While preliminary results are promising, further evaluation is needed to determine the feasibility of implementing OSTPP in this setting and effectiveness in reducing injection risk behaviors in Afghanistan.

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